Cefotetan is a second generation cephalosporin that inhibits bacterial cell wall synthesis. It is indicated for the treatment of the following bacterial infections:

• Bone and joint infections caused by:
  • Staphylococcus aureus.

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• Gynecologic infections (except Chlamydia (Chlamydophila) for which an appropriate therapy should be added) caused by:
  • Penicillinase- and non-penicillinase-producing strains S. aureus
  • Staphylococcus epidermidis
  • Streptococcus spp. excluding enterococci
  • Streptococcus agalactiae
  • Escherichia coli
  • Proteus mirabilis
  • Neisseria gonorrhoeae
  • Bacteroides spp. excluding Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron
  • Fusobacterium spp., and
  • gram-positive anaerobic cocci including Peptococcus and Peptostreptococcus spp.

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• Intra-abdominal infections caused by:
  • E. coli
  • Klebsiella spp. including K. pneumoniae
  • Streptococcus spp. excluding enterococci
  • Clostridium spp.

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• Lower respiratory tract infections caused by:
  • Streptococcus pneumoniae
  • penicillinase- and non-penicillinase-producing strains of S. aureus
  • Haemophilus influenzae including ampicillin-resistant strains
  • Klebsiella spp. including K. pneumoniae
  • E. coli
  • P. mirabilis
  • Serratia marcescens.

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• Used in conjunction with aminoglycosides for the treatment of gram-positive or gram-negative sepsis or in patients with other severe infections.

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• Skin and soft tissue infections caused by:
  • Penicillinase- and non-penicillinase-producing strains of S. aureus
  • Staphylococcus epidermidis
  • Streptococcus pyogenes
  • Streptococcus spp. excluding enterococci
  • E. coli
  • K. pneumoniae
  • Peptococcus niger
  • Peptostreptococcus spp.

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• For perioperative Surgical prophylaxis in contaminated or potentially contaminated procedures like a cesarean section, abdominal or vaginal hysterectomy, transurethral surgery, biliary tract surgery, and Gastrointestinal surgery.

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• Treatment of Urinary tract infections caused by:
  • E. coli
  • Klebsiella spp. including K. pneumoniae
  • P. mirabilis and other Proteus spp. including Proteus vulgaris, Providencia rettgeri, and Morganella morganii.

Cefotetan Dose in Adults

Use in the treatment of Susceptible infections:

• Usual dose: 1 - 2 gms Intramuscular or Intravenous twice daily.
• For life-threatening infections use 3 gms Intravenous twice daily to a maximum daily dose of 6 gms.
• A maximum dose of 4 gms/day should be used if administered via the intramuscular route.

Note: Due to high levels of B. fragilis group resistance, it is not advised for the treatment of community-acquired intraabdominal infections.

Use in treatment of Pelvic inflammatory disease:

• 2 gms intravenous twice daily in combination with doxycycline oral or
• If a tubo-ovarian abscess is present, oral clindamycin or oral metronidazole in combination with doxycycline is preferred to complete at least 14 days of therapy.

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Use in the treatment of Skin and skin structure infections:

• Mild to moderate infections:

Note: K. pneumoniae infections should be treated with 1 or 2 g intravenous or intramuscular twice daily.

• 1 g intramuscular or intravenous twice daily or
• 2 g intravenous every 24 hours
• Severe infections:
  • 2 g intravenous twice daily

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As perioperative for Surgical prophylaxis:

• 2 gms Intravenous within one hour prior to surgery.
• The dose may be repeated after 6 hours in lengthy procedures and if there is excessive blood loss.
• Manufacturer’s labeling:
  • 1 to 2 g Intravenous 30 - 60 minutes prior to surgery.

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Use in treatment of Urinary tract infection:

• • 1 to 2 g every 12 to 24 hours, or 500 mg intramuscularly or intravenously, twice daily.

Cefotetan Dose in Children

General dosing for susceptible infection:

• Infants, Children, and Adolescents:
  • Mild to moderate infections:
    • 30 mg/kg/dose IM or IV twice daily to a maximum single dose of 2,000 mg
  • Severe infections:
    • 50 mg/kg/dose as IM or IV twice daily to a maximum dose of 3,000 mg/dose.

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Use in the treatment of complicated Intraabdominal infections:

• Infants, Children, and Adolescents:
  • 20 to 40 mg/kg/dose intravenous twice daily.

Note: Due to high rates of B. fragilis group resistance, it is not advised for the treatment of community-acquired intraabdominal infections.

Cefotetan dose in Pelvic inflammatory disease:

• Adolescents:
  • 2 times a day, 2,000 mg intravenously, in addition to doxycycline.

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For the prevention of peritonitis in peritoneal dialysis patients having gastrointestinal or genitourinary surgery:

• Infants, Children, and Adolescents:
  • An intravenous dose of 30 to 40 mg/kg given 30 to 60 minutes prior to the surgery, with a dose cap of 2,000 mg.

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Dose in Surgical prophylaxis:

• Children and Adolescents:
  • 40 mg/kg intravenous one hour before the procedure to a maximum dose of 2000 mg. A re-dose may be required after 6 hours in lengthy surgical procedures

Pregnancy Risk Factor C

• It hasn't been tried on pregnant women, though. Studies on animal reproduction have not revealed any negative impacts on foetuses.
• In the cord serum and amniotic fluid, it passes the placental barrier and reaches therapeutic concentrations.
• It is recommended for use during cesarean deliveries.

Cefotetan use duringBreastfeeding:

• A nursing woman should be aware that it can be excreted in small amounts into breastmilk.

Cefotetan dosage in patients with renal impairment:

• CrCl of more than 30 mL/minute:
  • Dosage adjustment is necessary.
• CrCl of 10 -30 mL/minute:
  • Administer usual dose once a day or half the usual dose administered twice daily
• CrCl less than 10 mL/minute:
  • Administer usual dose every second day or 25% of the usual dose administered twice daily.
• End-stage renal disease (ESRD) on intermittent hemodialysis:
  • 5 - 20% of the drug is dialyzable. Administer 25% of the usual dose once a day on days between dialysis and 50% the usual dose on the day of dialysis (administer the dose after dialysis).

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Alternate recommendations (American Association of Family Physicians):

• GFR of more than 50 mL/minute/1.73 m²:
  • Dosage adjustment is not necessary.
• GFR of 10 - 50 mL/minute/1.73 m²:
  • Administer once daily.
• GFR of less than 10 mL/minute/1.73 m²:
  • Administer the dose every 48 hours.
• Peritoneal dialysis:
  • 1 gm every once daily.
• Continuous renal replacement therapy:
  • Administer once daily

Cefotetan Dose in Liver Disease:

The manufacturer has not recommended any dose adjustment in patients with liver disease.

Common Side effects Of Cefotetan Include:

• Gastrointestinal:
  • Diarrhea
• Hepatic:
  • Increased serum transaminases
• Hypersensitivity:
  • Hypersensitivity reaction

Contraindication to Cefotetan include:

• Allergy to cefotetan, other cephalosporins, or any component of the formulation.
• Hemolytic anemia has been documented in the past with the use of cephalosporins.

Warnings and Precautions

• Coagulopathy (Elevated iNR):
  • A rise in INR can lead to coagulopathy, which may be a sign of a condition called "coagulopathy".
  • This is especially true for patients who are nutritionally poor or have hepatic impairment.
• Hemolytic anemia
  • Immune-mediated hemolytic anemia may occur with cephalosporins that may be fatal if not diagnosed early.
  • The drug should be stopped and patients should be treated immediately.
• Allergy reactions:
  • Cefotetan may cause allergic reactions. It should be used with caution in patients with a history of hypersensitivity reactions to cephalosporin or penicillins
• Superinfection
  • Ceftriaxone treatment for longer periods (over 2 months) can lead to superinfections, including fungal or bacterial superinfections. 
  • C. difficile-associated diarrhea, (CDAD), and pseudomembranous collitis can occur.
• Gastrointestinal Disease:
  • Patients who have had colitis or a gastrointestinal condition should be cautious about taking the drug.
• Renal impairment
  • Patients with impaired renal function should be cautious when taking the drug. 

Cefotetan: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring Parameters:

Monitor the following parameters periodically with a prolonged therapy:

• Renal functions
• Hepatic functions
• Blood CBC and clinical features of hemolytic anemia.
• Prothrombin time especially in malnourished patients and patients with renal or hepatic impairment.

How to administer Cefotetan?

It may be administered as a deep intramuscular injection into a large muscle or injected as an intravenous injection directly over 3 - 5 minutes or as an infusion over 30 minutes.

Mechanism of action of Cefotetan:

Cefotetan

• This is a second-generation cephalosporin. It inhibits the formation bacterial proteins and prevents peptidoglycan formation by binding to penicillin-binding protein eventually leading to cell lysis via autolytic enzymes.

It is very populardistributedTo body tissues and fluids such as bile, gallbladder and skin, kidneys and tonsils. 88% of the drug can be found in urine.protein-bound. The half-life eliminationPatients with mildly impaired renal function may experience a delay of up to 4.6 hours. TheTime to achieve peak serum concentrationIt takes between 1 and 3 hours to recover from intramuscular injections. It isexcretedPrimarily via urine as an unchanged drug (50 to 80%).

International Brands of Cefotetan:

• Apacef
• Apatef
• Ceftenon
• Darvilen
• Kuptamete
• Maxtetan
• Trixosporin
• Yamatetan
• Cefotan

Cefotetan Brands in Pakistan:

No brands available in Pakistan